NCPA Supports Proposal for Qualified Expansion of Medication Therapy Management Programs in Medicare Part D Drug Plans

Published Online: Wednesday, December 11, 2013
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Alexandria, Va. Dec. 11, 2013 - The National Community Pharmacists Association (NCPA) today urged U.S. Senators on the Senate Finance Committee to support a proposal—scheduled for a vote as soon as Thursday, Dec. 12th—intended to expand coverage in the Medicare Part D prescription drug program of medication therapy management (MTM) programs.

The change is proposed by Senators Pat Roberts (R-Kan.) and Robert Casey (D-Penn.) as an amendment to legislation before the Senate committee that would temporarily prevent cuts to Medicare payments to physicians. The Roberts-Casey amendment would require the U.S. Centers for Medicare & Medicaid Services (CMS) to study whether the coverage of MTM services for patients with one chronic condition would reduce Medicare spending overall through the avoidance of costlier treatments such as hospitalizations. If CMS determines that the expansion in coverage would lower costs, then the expansion of MTM coverage would be required. Currently, only those patients suffering from specific multiple chronic conditions are eligible for MTM services.

MTM involves pharmacists working with patients to review and monitor their medication plan to maximize its effectiveness and avoid potential health problems, ultimately helping to reduce costs in the long run.

"Community pharmacists are highly trained medication experts and expanding the MTM services that they provide can achieve better health outcomes and lower overall costs," said NCPA CEO B. Douglas Hoey, RPh, MBA. "The challenges of not adhering to prescription drug therapy are real and expensive, and pharmacist-delivered MTM services can make a world of difference for patients. NCPA commends Senators Roberts and Casey for their work on this and encourages all Senators on the committee to support this bipartisan amendment."

The Roberts-Casey amendment stems from bipartisan legislation (S. 557, the Medication Therapy Management Empowerment Act) introduced by Senator Kay Hagan (D-N.C.) and cosponsored by Casey, Roberts and 28 other Senators.

Research indicates that the cost savings from MTM can be significant. One Minnesota study found a 12:1 return-on-investment for MTM. In North Carolina, MTM programs helping seniors produced a 13:1 return.

NCPA has long advocated for effective medication therapy management programs as a means to improve patient care. Seven years ago, NCPA created a company called Mirixa to work with community pharmacies and health plans in providing MTM services to Medicare and private patients. Since then, it has helped plans and payers lower overall health care costs and enhance the quality of care.
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